Direct Sub-Scarpal Lipectomy Combined with Liposuction in Abdominoplasty: An Analysis of Safety & Efficacy in 200 Consecutive Patients

Goals/Purpose: Abdominoplasty procedures continue to evolve as combining techniques such as suction-assisted lipectomy or direct sub-scarpal lipectomy have proven to be powerful adjuncts in order to achieve optimal aesthetic results. However, there is apprehension in combining these techniques simultaneously given the potential to affect the vascularity of the abdominoplasty flap. Therefore, the authors sought to assess the safety and efficacy of simultaneous direct sub-scarpal lipectomy combined with liposuction in abdominoplasty patients.

Methods/Technique: A 4-year retrospective review of all abdominoplasty patients (n = 200) performed by a single surgeon at Northwestern Memorial Hospital was conducted. Liposuction of the abdominal flap and flanks was performed in all 200 patients. After raising the abdominoplasty flap, undermining was performed to just beyond the xyphoid, lower rib margins superiorly, and to the anterior axillary line laterally. Fat deep to Scarpa’s fascia was then removed by direct tangential excision in all zones of the abdominal flap, including those considered at high risk for vascular compromise if subjected to liposuction after similar undermining.

Results/Complications: Average values are as follows: Age, 42.19; BMI, 28.10 kg/m2; Average follow up, 7 months. The rate of seroma formation was approximately 9.5 percent, superficial wound dehiscence treated with local wound care was 10 percent, hypertrophic scarring was 8 percent, partial umbilical necrosis was 0.5 percent, and umbilical epidermolysis was 3 percent. No patients experienced major or minor full-thickness tissue loss.

Conclusion: s: Simultaneous direct excision of sub-scarpal fat in conjunction with liposuction of the abdomen and flanks does not appear to subject any zone of the abdominoplasty flap to increased risks of vascular compromise. No flap necroses or major complications were observed despite prior concern for potential vascular compromise of the abdominoplasty flap. The use of our technique is safe and may provide superior abdominoplasty results.